Provider Demographics
NPI:1508966037
Name:NOLAN, MARK WARREN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WARREN
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-2018
Mailing Address - Country:US
Mailing Address - Phone:304-675-1222
Mailing Address - Fax:304-675-1224
Practice Address - Street 1:809 WILLOW LN
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2018
Practice Address - Country:US
Practice Address - Phone:304-675-1222
Practice Address - Fax:304-675-1224
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19111207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000026435OtherBCBS
WV0093555000Medicaid
OH2017203Medicaid
OH2017203Medicaid